Nursing students learn by doing

While on vacation in western North Carolina last week, Nicholas Soras, a type II diabetic, found himself in the hospital after his blood sugar spiked.

The situation could have turned grim, but nursing students at Haywood Community College were quick to respond by administering insulin and stabilizing the patient.

Luckily, Nicholas isn't a real person — he is one of two simulated computerized manikins being used at the college. Though not human, the nursing students at Haywood Community College must treat him that way. It's all part of the new Clinical Simulation Lab (Sim Lab) that helps prepare students for their career.

The manikins were purchased through grant funds through the federal Perkins Act and the Sim Lab was launched in January, becoming an integral part of the nursing curriculum.

The lab is set up to look like a two-bed hospital room, complete with high-tech equipment that would be seen in any hospital including screens that monitor vital signs and a station to hang IV fluids.

Michael Youngwood, clinical coordinator and lead nursing instructor, controls the dummies through the campus WiFi from a panel of three computers in the SIM lab. The impressive technology brings the dummies to life and students are required to detect and properly react to the patient's symptoms as they would if it were actually happening.

"These manikins are tactile sensitive. The moment you put hands on it, it knows," Youngwood said.

Sensors connected to the manikin body send signals that log every touch a student makes on the patient, from taking a pulse to touching its foot to check reflexes. The high-tech dummies flinch when a needle pokes them and their eyes are sensitive to light. They have heartbeats, sweat and their skin can turn blue with a lack of oxygen. They can even speak.

"I'm thirsty," said Nicholas.

And it doesn't stop there. Videos placed above the dummies allow Youngwood to go back and see if the students actually gave the patient water when he needed it. The dummy can even sense if it is being given the correct medicine.

In a single day by the end of the semester, the dummies can experience everything from pneumonia to a heart attack.

The college has gone to great lengths to make the learning experience as realistic as possible. Each day, students are given the patient's charts that Youngwood creates, complete with a medical record, allergy record and the symptoms they are showing.

Students use a phone to call the "doctor" or pharmacist when the situation warrants, and they are given orders to complete, just like they would in a real hospital.

There is a computer where students must log medication and a machine that distributes simulated medication.

"Are you doing OK? Do you feel any pain?" Mary Maney asked one of the dummies after inserting an IV in its arm.

Maney is a practical nurse taking the class this summer to become a registered nurse. She soothingly explained she would be back shortly to check on him.

"They only make the mistake of not speaking to the manikins once," Youngwood said with a laugh.

That's because speaking with the "patients" and making them feel comfortable is a big part of a nurse's job as well. Not doing so, even with a fake patient, "is a big no-no," Youngwood said.

When the simulation is over and the "patients" are stable, Youngwood then goes over the video and checks to make sure the students did everything correctly. As their semester goes on, students are expected to be able to recognize the patient's needs without any coaching from an instructor.

"My reaction is based on their interactions," Youngwood said. "If they miss something, I'm going to pick up on it and take it in a different direction."

One time, a dummy went into full-blown anaphylactic shock because the student failed to check the patient's allergy chart. But that's the best part about the sim lab — it's OK to make mistakes.

"Please, make mistakes all day long in here, but do it in here and not out there," Youngwood said.

Valuable learning

The Sim Lab gives students a bridge between bookwork and actually working with patients, which makes the learning experience more valuable, said Wendy Hines, health and human services department chair.

"In here we can let students make the mistakes, whereas in the hospital we have to stop them," Hines said.

As clinical work becomes more restrictive in the field, simulation has become an acceptable form of training. Up to 40 percent of nursing student's clinical hours can now be made up of simulation learning. That's why this lab has become so useful.

"They have to be able to practice somewhere," Hines said.

Jeff Minor, who is also working to become a registered nurse, said working in the simulation environment is teaching him more than just learning from a book.

"This focuses me and forces me to think three or four steps ahead, whereas if I'm taking a [written] test, if I make a mistake it doesn't effect what I'm doing next," he said.

The sim lab also gives the instructors a different way to teach.

"What if yesterday's lecture was about acute pancreatitis? What's the likelihood that you'd go to a hospital and see that the day of your clinical? Probably slim," Youngwood said.

But with the simulation lab, teachers are able to control what happens to the "patient" based on the level of knowledge the students have at that particular point in the semester. In a real hospital setting, anything can happen.

Last week, Nicholas came to the sim lab the day after they completed a lecture about type II diabetes.

When it comes time for students to begin clinicals in an actual patient-based setting, they are more prepared than ever after working in the sim lab, and that's an attractive skill for employers.

"Our local hospitals really like it. What they want us at nursing schools to do is teach as a proficiency model. You have to show me you can handle it in here before you go and represent our nursing school in a real patient setting," Hines said.

It also gives the students a chance to see what it's like to be in an authority role, which is something they wouldn't experience during an actual patient-based clinical.

"Students can play different roles like being the charge nurse," Hines said.

The role of nurses is just as vital in the medical community as doctors and pharmacists and the sim lab helps prepare students for all that will be expected of them.

"The doctor pops in and pops out," Youngwood said. "We are in the trenches 24 hours a day, seven days a week, 365 days a year. We are the eyes, the ears and the hands. The doctors have come to rely on the nurses because of our skill sets."

Looking over the students as they buzz around the sim lab practicing what they know and learning new skills, Hines can't help but be proud of what she sees. She knows that when her nursing students graduate, they are ready for their career.

"We're sending employers a student that has seen this all before," Hines said.